DocBox | PatientInfo

Select Doctor:

Visual Acuity

	UNCORRECTED RE	WITH GLASS RE	PH RE	UNCORRECTED LE	WITH GLASS LE	PH LE
DISTANCE.
NEAR.

Show Fundus Image

Spectacle Prescription

Enable

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Prescribed Medications:

NEWCopy Medicines

Procedure	Date	Quantity	Cost(Rs.)

Cash

Debit Card/Credit Card

Payment Gateway

Cheque/DD

UPI/Wallet Cashless/TPA/Insurance Payment link

Amount in Rs.
Description(optional)

	K1	Axis(K1)	K2	Axis(K2)	AXL	ACD	Lens Name	Formula	A-Const.	Exact Power	Available Power	Ref.Error
RE
LE

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Current Visit Spectacle Prescription

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Investigation Advised

Investigation Catagory:

Investigation Name:

Body Part

Investigation Name

Eye

Advising Doctor

Surgery Advised

Surgery Advised:

Description:

Eye:

Prognosis:

Surgery Name

Eye

Advising Doctor

Orthoptic Evaluation

Fixation Pref.

Head Posture

Hirschberg Test

Nystagmus

	Cover Test	Uncover Test	Alternate Cover Test
D
N
		Deviations

Ocular Movements Duction and Version - grading of overreaction and underactions


	RIGHT EYE


	LEFT EYE

PBRT/PBCT

Distance

Near

Rt Tilt	Lt Tilt

Sensory Evaluation

	Test	Fusion
< 3 Years	20 PD BO Test
	4 PD BO Test
	Test	Fusion
> 3 Years	4 PD BO Test
	WFDT (Distance)
	WFDT (Near)

Stereopsis

Test	Stereo Acuity

Additional Notes

Auto Refractometer

RIGHT EYE			LEFT EYE
Spherical	Cylinder	Axis	Spherical	Cylinder	Axis

Visual Acuity

	UNCORRECTED RE	WITH GLASS RE	PH RE	UNCORRECTED LE	WITH GLASS LE	PH LE
DISTANCE.
NEAR.

Dry Retinoscopy

	RIGHT EYE				LEFT EYE
	Spherical	Cylinder	Axis	Quality Of Reflex	Spherical	Cylinder	Axis	Quality Of Reflex
Distance

Dry Acceptance

Copy to Spectacle Prescription

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Spectacle Prescription

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Acceptance Under Fogging

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Previous Spectacle Prescription

Show Timeline

COPY	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Cycloplegic Retinoscopy

	RIGHT EYE				LEFT EYE
	Type	Spherical	Cylinder	Axis	Type	Spherical	Cylinder	Axis
Dist.

POST MYDRIATIC TEST

	RIGHT				LEFT
	SPH.	CYL.	AXIS.	V.A.	SPH.	CYL.	AXIS.	V.A.
distance.
addition.

Keratometry

	RE		LE
K1
K2

Color Blindness Test

Show Timeline

RE		1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24
LE		1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24

Policy Details

TPA:

Policy Number:

Insured Amount:

Bill Amount:

Start Date:

End Date:

Insured Details

Patient Relationship:

Primary Insurer:

Card Number:

Employee ID (if applicable):

Referral Number:

Claim Request

Claim Type:

Date Of Admission:

Date of Discharge(if applicable):

Comments:

Status*

Choose Item:

Quantity

Item Name

Item Quantity

Cost

Click to Choose File

Choose Catagory:

Surgery Uploaded Documents

Before Anesthesia
Patient has confirmed Identity Site Procedure Consent
Site Marked
History & Physical Reviewed
Presurgical Assessment Complete
Pre-Anesthesia Assessment Complete
Anesthesia Safety Check Done
Does Patient Have Difficult Airway/Aspiration Risk ? Not Applicable No Yes: Equipment/Assistance available History of Flomax/Alpha 1-A Inhibitor No Yes History of Anticogulants No Yes Continued Stopped as Instructed

Before Inscision
All team members have introduced themselves by name and role
Orally confirmed Patient Site Procedure Consent
Surgeon and Nurse Orally confirmed Antibiotic Mitomycin-c/Anti-Neoplastics Implants Style and Power Devices Tissues Gas Dyes
Anticipated critical events Surgeon Reviews Critical or unexpected None Anticipated Operation Duration Anesthesia Provider Reviews Any Patient Specific Concerns Nursing Team Reviews Sterility Equipment Issues Concerns

Before Leaving Operating Room
Does Patient Have Name of Procedure recorded Not Applicable Yes Instrument ,Sponge,Sharp count correct Not Applicable Yes Specimen Labeled Not Applicable Yes Equipment issue addressed Not Applicable Yes
Surgeon, Anesthesia provider and Nurse Key Concerns for recovery and management of patient reviewed

Intra op Vitals

Anesthesia Plan

Topical Anesthesia Local Anesthesia General Anesthesia Peribulbar Anesthesia Sub-Tenon Anesthesia

Basic Details

Surgery Date: Anaesthesiologist: Anesthesia: Total Time:

Irrigation Solution : BSS BSS Plus RL

Batch Num:

Surgery ID: Eye Operated: Procedure Name:

Contasol :

Batch Num:

Case Num: Pre-Op Diagnosis(OD): Assisting Nurse:

Viscoelastic :

Batch Num:

Surgeon: Pre-Op Diagnosis(OS): Circulating Nurse:

Trypan Blue :

Batch Num:

Enter Surgery Details :

IOL Record

Enter IOL serial Num :

Serial No.		Manufacturer
IOL Name		IOL Model
Batch No.		IOL Type
A Constant (Ultrasound)		A Constant (Optical)
Power		Optic Diameter
Aciol/Pciol		Mfd. Date
Exp. Date

Keratometry

	RE		LE
K1
K2

Cataract Surgery

Eye Preparation

Briddle Suture

Yes No

Cautery

Yes No

Incision Site

Axis

Incision Size

Configuration

Straight Frown Smilling Bevelled Two-Step Three-Step Back Cuts

Incision Location

Surgery Remarks:

Surgery Complications :

Surgery Notes:

Discharge card

Post op Vitals

Pain Score

Post op Medications

Pre op Vitals

Pre Op Medicine

Added Pre-Op Medicines

Templates

Systemic Pre Op Exam

Respiratory: CVS:

Diabetes: Hepatic:

Renal: Past Anesthetic History:

CNS: Venous Access Site:

Allergies:

Examination(IPD Nurse):

Nurse

Examination(Doctor):

Doctor

	Select to create NEW bill :	Logged in as : Administrator

Patient Name	PUID	Receipt Id	Date

Phone number	Address	Age/Gender	TPA	Policy No.

Patient Relation	Primary Insurer	Card Number	EmployeeId	Refferal Number

Date Of Admission		Date Of Discharge		Date Of Surgery

Select item from dropdown below:

Quantity

Procedure	Date	Quantity	Cost(Rs.)

Procedure	Date	Quantity	Cost(Rs.)

Amount paid Rs.:
Grand Total Rs.

Round Off Rs.
Amount discounted Rs.:
Amount due Rs.

Item Added

Patient Identity Confirmed	Yes No NA
Bill Payment Confirmation	Yes No NA
Patient Check-In Time	Yes No NA
Investigation Reports	Yes No NA
A Scan	Yes No NA
Toric IOL/ICL Marking by Surgeon	Yes No NA
Operation Site Identified and Mrked	Yes No NA
Consent signed by Patient	Yes No NA
Consent signed by Witness	Yes No NA
Consent signed by Surgeon	Yes No NA
Vitals Checked	Yes No NA
Patient has Known Allergy	Yes No NA
Pre Operative Medication Given	Yes No NA
Pre Operative slit-lamp examination is done	Yes No NA
PAC-Pre-Operative Anaesthesia Check up is done and Documented	Yes No NA
Dilation Done	Yes No NA
Informed surgeon/anaesthesia/ot	Yes No NA

Select Doctor:	Select Anesthetist:
Booking Status Waiting Confirmed	Procedures
Select Surgery Date:	Select Surgery Time:
Attach Receipt
Eye Operated	Remarks

Visits Details

Visual Acuity

Spectacle Prescription

Transfer Patient

Request ratings from patient

Start Dilation

Medication Details

Add Diagnosis

Add Note

Add Note

Detailed Sub Catagory

Right Eye

Left Eye

Add Allergies

Add Medical History

Add Birth History

Add Surgical History

Add Family History

Add Current Treatment

Add Nutritional History

Add Immunisation History

Add Ocular History

Preview

Book Appointment

Enter Payment Amount

Choose Bed

No IPD data defined.

Please configure IPD settings.

Choose Date of Discharge

Enter Biometry

IOP Timeline

Investigation Advised

Surgery Advised

Visit Change Log

Choose Next Visit

Choose Date Range

Select date of admission and discharge

Select date of surgery

Detailed Examination Findings

ANTERIOR SEGMENT

POSTERIOR SEGMENT

Orthoptic Evaluation

Fixation Pref. Select Option Right Left Alternate

Head Posture

Hirschberg Test

Nystagmus

Deviations Select Option Concomitant Incomitant

Ocular Movements Duction and Version - grading of overreaction and underactions

PBRT/PBCT

Distance

Near

Sensory Evaluation

Stereopsis

Auto Refractometer

Visual Acuity

Dry Retinoscopy

Dry Acceptance

Spectacle Prescription

Acceptance Under Fogging

Previous Spectacle Prescription

Cycloplegic Retinoscopy

POST MYDRIATIC TEST

Keratometry

Color Blindness Test

Refraction Filling Chart

Distance(Spherical RE)

Distance(Cylinder RE)

Distance(AXIS RE)

Distance(VA RE)

Addition(Spherical RE)

Addition(VA RE)

Distance(Spherical LE)

Distance(Cylinder LE)

Distance(AXIS LE)

Distance(VA LE)

Addition(Spherical LE)

Addition(VA LE)

Distance(Spherical RE)

Distance(Cylinder RE)

Distance(AXIS RE)

Fixation Pref.

Deviations